Provider Demographics
NPI:1023106127
Name:BODYWISE STUDIOS, INC.
Entity type:Organization
Organization Name:BODYWISE STUDIOS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:POLAND
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-794-6760
Mailing Address - Street 1:PO BOX 5538
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-5538
Mailing Address - Country:US
Mailing Address - Phone:904-794-6760
Mailing Address - Fax:904-794-6760
Practice Address - Street 1:2706 OLD MOULTRIE RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5447
Practice Address - Country:US
Practice Address - Phone:904-794-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 12766261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3051Medicare ID - Type UnspecifiedPHYSICAL THERAPY